Tested by Fire

In the world of humanitarian aid, Medicins Sans Frontiers, a.k.a. Doctors Without Borders, is a bit of an outlaw. Shunning the silence imposed on volunteers by organizations like the Red Cross, MSF workers are unafraid to call for international action in regions where they practice. Since their founding in 1972, MSF has maintained financial independence by refusing to accept government funding, a circumstance which puts them in a unique position to speak out. As a relief organization, their mission is clear: deliver emergency aid to the more than two billion people affected by armed conflict, epidemics, natural or man-made disasters, or exclusion from health care in more than seventy countries. It is not uncommon for MSF teams to arrive just as other aid agencies are pulling their staffs out of conflicted regions due to security concerns. In 1999, the group was awarded the Nobel Prize.

Almost from day one, camera crews have asked permission to document the group’s efforts. Of the first twenty-eight to apply, all were categorically refused. Yet first time director Mark Hopkins, a native of Kenya, got a green light after being put through a rigorous trial by fire in the deserts of Niger. Hopkins spent three years creating the documentary Living in Emergency: Stories of Doctors Without Borders, which will be in theaters in December 2009.

The film chronicles the experiences of four doctors, including Australian anaesthetist Chris Brasher, as they cope with the chaos of war’s aftermath in Liberia, Malawi and the Congo without the back-up of technology, trained support staff or specialists to consult. Stress and a continual state of trauma clearly take their toll, and the doctors demonstrate very human vulnerabilities while performing extraordinary feats of medicine. The film offers an unprecedented look at a way of life that is often glorified but rarely understood.

Brasher, a nine-year veteran of MSF, has experienced numerous scenarios unheard of in western hospitals. He has performed anesthetics as the surgeon relieved a brain hematoma using the wrong drill bit (the only drill bit available) and participated in the import and distribution of life-saving AIDS medications in direct defiance of Bush administration policies regarding African nations. Over the years he has practiced medicine under incredibly inhospitable and occasionally dangerous circumstances. Hopkins and Brasher spoke with SuperConsciousness from Paris, where Brasher currently practices pediatrics.

SC: What are some of the common misconceptions about MSF that your film addresses?

Hopkins: MSF and a lot of the humanitarian workers in general suffer from a rather two-dimensional understanding of the work and the role that it plays in western society. There is the sort of hero-esque, save the world aura that’s attached to it. The second part is the distancing mechanism that people in the west use to say, “Well, obviously I could never do anything like that,” that sort of “hold hands, sing ‘Kum Ba Ya,’ these are such noble people” attitude. That’s completely not the reality.

SC: Given all of your experiences, what is your perspective on altruism?

Hopkins: From my point of view, people confuse the ideas of being selfish and being self-centered. If you’re being selfish and you’re doing what’s interesting to you that actually helps patients in difficult situations, this whole aura of messianic do-gooder doesn’t really apply. That sort of noble idea of people making tremendous sacrifice, I’m not sure how accurate that is.

Brasher: The altruism that I’ve always had shoved down my throat, I think is a lie. I don’t think it exists.

SC: And what is that?

Brasher: This whole sainthood thing that there are these pure, abstract moral beings that exist for the good of others, I think that’s rubbish. That’s for people who do things for other people to get a benefit from it, and if they can’t express that in another fashion, they say, “I live for everybody else. I don’t live for myself.” I think that’s a lie.

I don’t believe in the religious image, the whole Mother Theresa thing. Mother Theresa did stuff because, at the end of the day, she was happy. I suppose there are some people who are doing humanitarian work that have much more to do with the public image of it.

"From my point of view, people confuse the ideas of being selfish and being self-centered. If you’re being selfish and you’re doing what’s interesting to you that actually helps patients in difficult situations, this whole aura of messianic do-gooder doesn’t really apply"

SC: Mark was alluding to the fact that people tend to put humanitarian workers on a pedestal as part of not taking responsibility themselves; it releases them from a sense of responsibility. Do you agree with that?

Brasher: I don’t know, really. I don’t have a great view of what the general public thinks. It’s certainly something people say to me all the time at work: “I could never do that.” Couldn’t, don’t want to – I just don’t get it, that there’s something that makes me different to them. I think the main difference is that I want to do it and they don’t want to do it. I’ve found that most people aren’t really interested.

"People say to me all the time at work: “I could never do that.” Couldn’t, don’t want to – I just don’t get it, that there’s something that makes me different to them. I think the main difference is that I want to do it and they don’t want to do it"

SC: Do social relationships in the field become deeper much quicker because you’re not dealing with all the extraneous stuff?

Brasher: Oh, definitely. I’d go further than that. I’d say falsely profound relationships. I’ve had friendships working with MSF and afterwards I’ve said to myself, “That was just not real.” It was context-related to being stuck in some shithole with somebody with whom you’ve got nothing in common and with whom you wouldn’t usually make the effort to connect or have that bond.

SC: But do you feel, regardless of whether it’s a friendship or not, that you at least know what you can count on the person for?

Brasher: Exactly. You can’t ignore the bond. It just seems very strange when you meet those people out of that context, which happened to me working in the head office here. Just about every week, I’d run into somebody that I’d been stuck in some shithole with, that I hadn’t seen for a year or two, and I’d try to talk to them out of that context. That’s very challenging. But there’s a very strong bond and it’s hard to explain in the way that we usually relate.

SC: The flip side of that seems to be that the re-entry into civilian life is difficult with people not understanding or not caring to know what you’ve been doing.

Brasher: It’s impossible, really, to talk about for any length of time without people’s eyes glazing over. The average is about four minutes. Part of my motivation for working with Mark on the film was being able to explain myself in a way that people could understand. I know that I can show them the film now, and that explains a lot of things that I would never have been able to sit down and talk to them about.

SC: You did this work for nine years. How has it changed you, and what keeps you hopeful, with everything that you’ve seen?

"Part of my motivation for working with Mark on the film was being able to explain myself in a way that people could understand. I know that I can show them the film now, and that explains a lot of things that I would never have been able to sit down and talk to them about"

Brasher: One really obvious thing to me is that over time I became less and less burdened with all the sort of programmed worries of western society. It’s made me simpler. Crap that a lot of people I know get quite upset about doesn’t even register anymore. That’s a real lasting positive change. I was able to put those worries aside and joke about them like, do I change my health insurance? What about my life insurance policy? Is my computer connection good enough? But it also means that you end up thinking about things that are more important a bit more, and then you can appear quite boring and serious to people. In the same way, when you want to have fun, you seriously have fun, so I think you become a bit more extreme in some ways.

It didn’t really change my level of hope. It just made things into three-dimensions; it made them more real. I didn’t think that there weren’t wars going on in the world; I didn’t think those wars were going to stop; I didn’t think that everybody in the world had central heating. It just made it all sharper and clearer, and made me sure about all of that. I can really feel it, whereas before I just sort of vaguely knew these things were true.

SC: The tolls that this kind of work can take are fairly clear, but what are some of the benefits that people may not be aware of?

Hopkins: It’s a question of what you find interesting and rewarding. If you’re looking at the challenge of working in a very difficult environment with fairly limited resources and yet achieving a very high standard of results, there are people that will rise to that challenge and find it immensely rewarding.

There’s a big gap between the sort of lives people live in the west and the types of lives people are living in the situations where humanitarian doctors work. Trying to communicate that in the film is difficult because you’re trying to give people an experience that in a way can only be understood if you’ve lived it.

Brasher: A lot of people will feel satisfaction in working in that kind of setting through the returns that they get. It’s a kind of bartering; you offer something that’s more precious to people in difficult conditions than it is to people in wealthy countries. So the returns in terms of sharing wisdom and exchange are much more intense and most people can identify them if they can get over the shock of being out of their usual context.

"People react differently depending on the way they feel, the way they’ve been brought up, and their life experiences. Not everybody will automatically react constructively to difficult situations and that’s something that you see when people are taken out of their usual context and confronted by things they don’t expect"

SC: One of the doctors in this film says, “I’m not doing anything extraordinary. I’m just doing what anyone in the same situation would have done.” What’s your perspective on that?

Brasher: I don’t think that’s true. People react differently depending on the way they feel, the way they’ve been brought up, and their life experiences. Not everybody will automatically react constructively to difficult situations and that’s something that you see when people are taken out of their usual context and confronted by things they don’t expect.

Hopkins: I think it’s a degree of how close you get. If you go by a car crash, there’s a human impulse to get out and help. Conceptually, you’ve got car crashes happening in countries very far away. The idea of going to do something and help, it’s not as immediate and close to you. It takes a different level of immediacy to trigger that in different people.

SC: In terms of the freedom of practicing medicine, certainly in the U.S. with the weight of malpractice there’s a lot less freedom to do what you’re trained to do than there might be under other circumstances.

Brasher: Practicing in France or in Australia, I don’t feel restricted by those kinds of issues. It’s not a question of freedom when you’re practicing on your own, it’s a question of becoming much more self-reliant than when you practice in a wealthy context. Within a wealthy context, it’s much more collegial. At any time, you can ask somebody who specializes in the area you’ve got doubts on, or somebody who does that one particular little thing all the time, whereas when you’re on your own you have to wing it, and make decisions about lots of things that you would usually ask for advice about.

So I don’t see that as freedom at all; I see it as pressure. But at the same time, it does build skills that aren’t really built in western settings, skills of common sense and logical decision making despite relative lack of technology and knowledge.

SC: As a humanitarian organization rather than a developmental one, MSF is usually dealing with effects rather than causes. The causes don’t change that much, because they are the result of politics or foreign policy. How do you deal with that in terms of frustration or despair? Does the advocacy aspect of MSF alleviate any of that?

Brasher: We usually actually feel that it’s freedom. Most of the time, development comes through domination of other populations and exploitation.* The whole idea of us sitting around and sending over a few guys in suits and things are going to get better somewhere is just rubbish.

SC: Some countries, the U.S. in particular, have co-opted humanitarian aid as part of their foreign policy, which has significantly muddied the waters for aid workers everywhere, and made it more dangerous for many of them. Have you encountered the fallout from that?

Brasher: Not a great deal. With MSF the problem is much more the colonial issues, particularly French. Post-colonial France has had a strong political influence in quite a few of the countries where I’ve worked, and the identification of the organization as being French was much more of a problem. The association of the organization with the French government’s actions was at times quite dangerous. In Burundi, the French people are very unwelcome, and I, as an Australian, was sent there repetitively as part of a drive to try and dilute the bad feelings toward them.

In terms of muddying the waters, the people in those countries have to align these rich, white wankers with the actions of the rich white governments in the world. I don’t think sponsorship and finances and spying (we’ve heard about the spying issues with CARE being accused of spying for America) have very much influence at all. What is more important is that you cannot disassociate yourself [in the minds of the people you’re there to assist] from the mass of the people on the planet who’ve got most of the money and run the show.

"We’re not trying to preach. In a broader sense, you would hope that people would feel a certain appreciation for the life that they live"

SC: What do you hope will be the impact of this film?

Hopkins: It’s a film which, hopefully, people will find engaging. We’re not trying to preach. In a broader sense, you would hope that people would feel a certain appreciation for the life that they live. Most people who are in the context that we’re looking at in the film won’t be able to buy a movie ticket. If you live in the west, you have the luxury of being able to go and see films, and it would not be a bad thing if people can feel a sense of their own good fortune.

*Brasher made it clear that he was speaking for himself on this point, rather than expressing an official perspective held by MSF.*